Should Type 2 Diabetics go keto?

I think the short answer is, “Yes!”. But why?

What is Type 2 Diabetes?

Type 2 diabetes is a condition where blood glucose levels are higher than normal. Unlike Type 1 Diabetes where a lack of insulin from the pancreas is the cause of high blood sugars, in Type 2 Diabetes insulin levels are generally very high but the insulin is not able to keep blood glucose levels within a normal range. The reason for this is insulin resistance, where despite high levels of insulin, cells are no longer able to take in enough glucose from the blood stream to maintain normal blood sugar levels.

What causes insulin resistance?

Insulin resistance is caused by chronically high levels of insulin. Why would insulin levels be elevated all the time? While there are other factors that can increase insulin production, the most powerful one is dietary carbohydrates. When we eat anything, our insulin increases…unless we’re consuming pure fat, but a nice glass of olive oil or steaming hot cup of lard isn’t very appealing, is it? So every time we eat, insulin is secreted by our pancreas. When we eat carbohydrates, especially processed carbohydrates like sugary soda and juices, bread, crackers, desserts, pasta, and rice, our blood glucose levels go up, and insulin is secreted to push that glucose into our muscles, liver, and fat cells for storage as either glycogen or fat. Protein also causes insulin to be produced, but much less than processed carbohydrates. Eating frequent meals and snacks, especially those higher in carbs, will result in chronically elevated glucose and therefore insulin levels.

Remember, insulin’s most important function is to push glucose out of the bloodstream and into storage either as glycogen in the muscles and liver, or as new fat in our fat cells. This keeps our blood sugar at safe levels. As our cells get stuffed full, the amount of insulin it takes to push glucose into our cells increases. Instead of insulin levels dropping down between meals, they are constantly high, spiking even higher when more carbohydrates are eaten.

If this cycle continues, eventually the amount of insulin required to push glucose into storage is more than the pancreas can produce, and blood sugar levels rise. It is only at this point that Type 2 diabetes is diagnosed, but you can see that it’s not an overnight occurrence. It’s a gradual increase in insulin resistance caused by consistently high blood glucose levels, caused by frequent consumption of processed carbohydrate foods.

But isn’t there a pill for that?

I’ll let Dr. Jason Fung, nephrologist and author of the Diabetes Code answer that one:

Standard medications do not prevent the progression of organ failure because they do not help excrete the toxic sugar load. No less than seven multinational, multicenter, randomized, placebo-controlled trials have proved that standard medications that lower blood glucose do not reduce heart disease, the major killer of diabetic patients. We have pretended that these glucose-lowering medications make people healthier, but it’s been a lie. We have overlooked a singular truth: you can’t use drugs to cure a dietary disease.

Dr. Jason Fung, pg xix, The Diabetes Code

Where does the keto diet come into this?

Ketosis, or the presence of ketones, occurs when blood sugar (glucose) levels are low, allowing levels insulin to decrease. Only when insulin levels are low can our bodies have access to our fat stores to use as energy. Access to our fat stores means we are fat-burners instead of sugar-burners. If we’re only able to use the sugar we ingested in our last meal, we run out of energy quickly and can get “hangry” when our blood glucose levels drop. When we are in fat-burning mode energy is constant; it’s not dependent on what we ate or how long since our last meal.

How to get your blood glucose to go down low enough for ketosis? Decrease your carbohydrate intake – to around 20 grams per day. This is a keto (or ketogenic) diet. If carbohydrates are very low, insulin will decrease and that decrease in insulin will allow your body to burn fat. It’s not an instantaneous conversion, and it may result in a temporary decrease in energy – but our bodies know what to do, they will burn what they are given. In this case, you cut the carbohydrates way down, and increase the fat in your meals, protein stays at moderate levels.

Nutritional ketosis for someone with Type 2 diabetes means their blood sugars are low enough to allow their bodies to use fat for energy instead of sugar. Upon adopting a keto way of eating, blood sugar readings should decrease rapidly as glucose in the blood and glycogen in the muscles and liver is depleted. As this effect can be pretty quick, it’s important to check with your physician about how to manage diabetes medications when changing your diet.

Dr. Sarah Hallberg, now of Virta Health, gave an excellent TED talk about the use of diet in reversing Type 2 diabetes back in 2015. The evidence for the effectiveness of a ketogenic diet has only increased in the past four years.

From the 2019 Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report from the American Diabetes Association: (sections in bold – my added emphasis)

The amount of carbohydrate intake required for optimal health in humans is unknown. Although the recommended dietary allowance for carbohydrate for adults without diabetes (19 years and older) is 130 g/day and is determined in part by the brain’s requirement for glucose, this energy requirement can be fulfilled by the body’s metabolic processes, which include glycogenolysis, gluconeogenesis (via metabolism of the glycerol component of fat or gluconeogenic amino acids in protein), and/or ketogenesis in the setting of very low dietary carbohydrate intake (49).

https://doi.org/10.2337/dci19-0014

The National Academy of Medicine has defined an acceptable macronutrient distribution for total fat for all adults to be 20–35% of total calorie intake (49). Eating patterns that replace certain carbohydrate foods with those higher in total fat, however, have demonstrated greater improvements in glycemia and certain CVD risk factors (serum HDL cholesterol [HDL-C] and triglycerides) compared with lower fat diets. The types or quality of fats in the eating plans may influence CVD outcomes beyond the total amount of fat (63). Foods containing synthetic sources of trans fats should be minimized to the greatest extent possible (8). Ruminant trans fats, occurring naturally in meat and dairy products, do not need to be eliminated because they are present in such small quantities (64).

https://doi.org/10.2337/dci19-0014

EATING PATTERNS
Consensus recommendations
A variety of eating patterns (combinations of different foods or food groups) are acceptable for the management of diabetes.
Until the evidence surrounding comparative benefits of different eating patterns in specific individuals strengthens, health care providers should focus on the key factors that are common among the patterns:
○ Emphasize nonstarchy vegetables.
○ Minimize added sugars and refined grains.
○ Choose whole foods over highly processed foods to the extent possible.
Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia and may be applied in a variety of eating patterns that meet individual needs and preferences.
For select adults with type 2 diabetes not meeting glycemic targets or where reducing antiglycemic medications is a priority, reducing overall carbohydrate intake with low- or very low-carbohydrate eating plans is a viable approach.

https://doi.org/10.2337/dci19-0014

These sections from the ADA report show a huge change from previous ADA recommendations. The evidence is in (and more is coming) that a LCHF or ketogenic way of eating is an effective and healthy way to treat and possibly reverse Type 2 diabetes! There are many “bonus” effects of keto, not the least of which is comfortable, hunger free weight loss.

I’m not a doctor or other licensed medical professional. Please use your own judgement and consult with your doctor before making dietary changes that may affect your health, especially if you are currently taking prescription medications.

I’m passionate about the many benefits of keto and intermittent fasting! Please comment or contact me with questions.

Thanks, Kayla

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